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Research Papers

Selective Laser Sintered Versus Carbon Fiber Passive-Dynamic Ankle-Foot Orthoses: A Comparison of Patient Walking Performance

[+] Author and Article Information
Nicole G. Harper

Department of Mechanical Engineering,
The University of Texas at Austin,
Austin, TX 78712
e-mail: nicole.harper@utexas.edu

Elizabeth M. Russell

Center for the Intrepid,
Department of Orthopaedics and Rehabilitation,
Brooke Army Medical Center,
Ft. Sam Houston, TX 78234
e-mail: elizabeth.m.russell34.ctr@mail.mil

Jason M. Wilken

Center for the Intrepid,
Department of Orthopaedics and Rehabilitation,
Brooke Army Medical Center,
Ft. Sam Houston, TX 78234
e-mail: Jason.m.wilken.civ@mail.mil

Richard R. Neptune

Department of Mechanical Engineering,
The University of Texas at Austin,
Austin, TX 78712
e-mail: rneptune@mail.utexas.edu

1Corresponding author.

Manuscript received December 12, 2013; final manuscript received May 22, 2014; accepted manuscript posted May 29, 2014; published online June 26, 2014. Assoc. Editor: Paul Rullkoetter.

J Biomech Eng 136(9), 091001 (Jun 26, 2014) (7 pages) Paper No: BIO-13-1575; doi: 10.1115/1.4027755 History: Received December 12, 2013; Revised May 22, 2014; Accepted May 29, 2014

Selective laser sintering (SLS) is a well-suited additive manufacturing technique for generating subject-specific passive-dynamic ankle-foot orthoses (PD-AFOs). However, the mechanical properties of SLS PD-AFOs may differ from those of commonly prescribed carbon fiber (CF) PD-AFOs. Therefore, the goal of this study was to determine if biomechanical measures during gait differ between CF and stiffness-matched SLS PD-AFOs. Subject-specific SLS PD-AFOs were manufactured for ten subjects with unilateral lower-limb impairments. Minimal differences in gait performance occurred when subjects used the SLS versus CF PD-AFOs. These results support the use of SLS PD-AFOs to study the effects of altering design characteristics on gait performance.

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References

Patzkowski, J. C., Blanck, R. V., Owens, J. G., Wilken, J. M., Kirk, K. L., Wenke, J. C., and Hsu, J. R., 2012, “Comparative Effect of Orthosis Design on Functional Performance,” J. Bone Joint Surg. Am., 94(6), pp. 507–515. [CrossRef] [PubMed]
Neptune, R. R., Kautz, S. A., and Zajac, F. E., 2001, “Contributions of the Individual Ankle Plantar Flexors to Support, Forward Progression and Swing Initiation During Walking,” J. Biomech., 34(11), pp. 1387–1398. [CrossRef] [PubMed]
Liu, M. Q., Anderson, F. C., Pandy, M. G., and Delp, S. L., 2006, “Muscles That Support the Body Also Modulate Forward Progression During Walking,” J. Biomech., 39(14), pp. 2623–2630. [CrossRef] [PubMed]
Allen, J. L., and Neptune, R. R., 2012, “Three-Dimensional Modular Control of Human Walking,” J. Biomech., 45(12), pp. 2157–2163. [CrossRef] [PubMed]
Pandy, M. G., Lin, Y. C., and Kim, H. J., 2010, “Muscle Coordination of Mediolateral Balance in Normal Walking,” J. Biomech., 43(11), pp. 2055–2064. [CrossRef] [PubMed]
Owens, J. G., Blair, J. A., Patzkowski, J. C., Blanck, R. V., and Hsu, J. R., 2011, “Return to Running and Sports Participation After Limb Salvage,” J. Trauma, 71(1 Suppl), pp. S120–S124. [CrossRef] [PubMed]
Buckon, C. E., Thomas, S. S., Jakobson-Huston, S., Moor, M., Sussman, M., and Aiona, M., 2004, “Comparison of Three Ankle-Foot Orthosis Configurations for Children With Spastic Diplegia,” Dev. Med. Child Neurol., 46(9), pp. 590–598. [CrossRef] [PubMed]
Bregman, D. J., De Groot, V., Van Diggele, P., Meulman, H., Houdijk, H., and Harlaar, J., 2010, “Polypropylene Ankle Foot Orthoses to Overcome Drop-Foot Gait in Central Neurological Patients: A Mechanical and Functional Evaluation,” Prosthet. Orthot. Int., 34(3), pp. 293–304. [CrossRef] [PubMed]
Gok, H., Kucukdeveci, A., Altinkaynak, H., Yavuzer, G., and Ergin, S., 2003, “Effects of Ankle-Foot Orthoses on Hemiparetic Gait,” Clin. Rehabil., 17(2), pp. 137–139. [CrossRef] [PubMed]
Lehmann, J. F., Condon, S. M., De Lateur, B. J., and Price, R., 1986, “Gait Abnormalities in Peroneal Nerve Paralysis and Their Corrections by Orthoses: A Biomechanical Study,” Arch. Phys. Med. Rehabil., 67(6), pp. 380–386. [PubMed]
Tyson, S. F., and Thornton, H. A., 2001, “The Effect of a Hinged Ankle Foot Orthosis on Hemiplegic Gait: Objective Measures and Users' Opinions,” Clin. Rehabil., 15(1), pp. 53–58. [CrossRef] [PubMed]
Buckon, C. E., Thomas, S. S., Jakobson-Huston, S., Sussman, M., and Aiona, M., 2001, “Comparison of Three Ankle-Foot Orthosis Configurations for Children With Spastic Hemiplegia,” Dev. Med. Child Neurol., 43(6), pp. 371–378. [CrossRef] [PubMed]
Lehmann, J. F., Condon, S. M., De Lateur, B. J., and Smith, J. C., 1985, “Ankle-Foot Orthoses: Effect on Gait Abnormalities in Tibial Nerve Paralysis,” Arch. Phys. Med. Rehabil., 66(4), pp. 212–218. [CrossRef] [PubMed]
De Wit, D. C., Buurke, J. H., Nijlant, J. M., Ijzerman, M. J., and Hermens, H. J., 2004, “The Effect of an Ankle-Foot Orthosis on Walking Ability in Chronic Stroke Patients: A Randomized Controlled Trial,” Clin. Rehabil., 18(5), pp. 550–557. [CrossRef] [PubMed]
Ramstrand, N., and Ramstrand, S., 2010, “AAOP State-of-the-Science Evidence Report: The Effect of Ankle-Foot Orthoses on Balance—A Systematic Review,” J. Prosthet. Orthot., 22, pp. 4–23. [CrossRef]
Faustini, M. C., Neptune, R. R., Crawford, R. H., and Stanhope, S. J., 2008, “Manufacture of Passive Dynamic Ankle-Foot Orthoses Using Selective Laser Sintering,” IEEE Trans. Biomed. Eng., 55(2 Pt 1), pp. 784–790. [CrossRef] [PubMed]
Danielsson, A., and Sunnerhagen, K. S., 2004, “Energy Expenditure in Stroke Subjects Walking With a Carbon Composite Ankle Foot Orthosis,” J. Rehabil. Med., 36(4), pp. 165–168. [CrossRef] [PubMed]
Desloovere, K., Molenaers, G., Van Gestel, L., Huenaerts, C., Van Campenhout, A., Callewaert, B., Van De Walle, P., and Seyler, J., 2006, “How Can Push-Off Be Preserved During Use of an Ankle Foot Orthosis in Children With Hemiplegia? A Prospective Controlled Study,” Gait Posture, 24(2), pp. 142–151. [CrossRef] [PubMed]
Van Gestel, L., Molenaers, G., Huenaerts, C., Seyler, J., and Desloovere, K., 2008, “Effect of Dynamic Orthoses on Gait: A Retrospective Control Study in Children With Hemiplegia,” Dev. Med. Child Neurol., 50(1), pp. 63–67. [CrossRef] [PubMed]
Wolf, S. I., Alimusaj, M., Rettig, O., and Doderlein, L., 2008, “Dynamic Assist by Carbon Fiber Spring AFOs for Patients With Myelomeningocele,” Gait Posture, 28(1), pp. 175–177. [CrossRef] [PubMed]
Bartonek, A., Eriksson, M., and Gutierrez-Farewik, E. M., 2007, “Effects of Carbon Fibre Spring Orthoses on Gait in Ambulatory Children With Motor Disorders and Plantarflexor Weakness,” Dev. Med. Child Neurol., 49(8), pp. 615–620. [CrossRef] [PubMed]
Schrank, E. S., and Stanhope, S. J., 2011, “Dimensional Accuracy of Ankle-Foot Orthoses Constructed by Rapid Customization and Manufacturing Framework,” J. Rehabil. Res. Dev., 48(1), pp. 31–42. [CrossRef] [PubMed]
Creylman, V., Muraru, L., Pallari, J., Vertommen, H., and Peeraer, L., 2013, “Gait Assessment During the Initial Fitting of Customized Selective Laser Sintering Ankle Foot Orthoses in Subjects With Drop Foot,” Prosthet. Orthot. Int., 37(2), pp. 132–138. [CrossRef] [PubMed]
Pallari, J. H., Dalgarno, K. W., and Woodburn, J., 2010, “Mass Customization of Foot Orthoses for Rheumatoid Arthritis Using Selective Laser Sintering,” IEEE Trans. Biomed. Eng., 57(7), pp. 1750–1756. [CrossRef] [PubMed]
Salles, A. S., and Gyi, D. E., 2013, “An Evaluation of Personalised Insoles Developed Using Additive Manufacturing,” J. Sports Sci., 31(4), pp. 442–550. [CrossRef] [PubMed]
Faustini, M. C., Neptune, R. R., Crawford, R. H., Rogers, W. E., and Bosker, G., 2006, “An Experimental and Theoretical Framework for Manufacturing Prosthetic Sockets for Transtibial Amputees,” IEEE Trans. Neural Syst. Rehabil. Eng., 14(3), pp. 304–310. [CrossRef] [PubMed]
Rogers, B., Bosker, G., Faustini, M., Walden, G., Neptune, R. R., and Crawford, R., 2008, “Case Report: Variably Compliant Transtibial Prosthetic Socket Fabricated Using Solid Freeform Fabrication,” J. Prosthet. Orthot., 20(1), pp. 1–7. [CrossRef]
Rogers, B., Bosker, G. W., Crawford, R. H., Faustini, M. C., Neptune, R. R., Walden, G., and Gitter, A. J., 2007, “Advanced Trans-Tibial Socket Fabrication Using Selective Laser Sintering,” Prosthet. Orthot. Int., 31(1), pp. 88–100. [CrossRef] [PubMed]
Fey, N. P., Klute, G. K., and Neptune, R. R., 2011, “The Influence of Energy Storage and Return Foot Stiffness on Walking Mechanics and Muscle Activity in Below-Knee Amputees,” Clin. Biomech. (Bristol, Avon), 26(10), pp. 1025–1032. [CrossRef] [PubMed]
Ventura, J. D., Klute, G. K., and Neptune, R. R., 2011, “The Effects of Prosthetic Ankle Dorsiflexion and Energy Return on Below-Knee Amputee Leg Loading,” Clin. Biomech. (Bristol, Avon), 26(3), pp. 298–303. [CrossRef] [PubMed]
Ventura, J. D., Klute, G. K., and Neptune, R. R., 2011, “The Effect of Prosthetic Ankle Energy Storage and Return Properties on Muscle Activity in Below-Knee Amputee Walking,” Gait Posture, 33(2), pp. 220–226. [CrossRef] [PubMed]
Geboers, J. F., Drost, M. R., Spaans, F., Kuipers, H., and Seelen, H. A., 2002, “Immediate and Long-Term Effects of Ankle-Foot Orthosis on Muscle Activity During Walking: A Randomized Study of Patients With Unilateral Foot Drop,” Arch. Phys. Med. Rehabil., 83(2), pp. 240–245. [CrossRef] [PubMed]
Smith, J. D., and Martin, P. E., 2011, “Short and Longer Term Changes in Amputee Walking Patterns Due to Increased Prosthesis Inertia,” J. Prosthet. Orthot., 23(3), pp. 114–123. [CrossRef]
Vaughan, C. L., and O'malley, M. J., 2005, “Froude and the Contribution of Naval Architecture to Our Understanding of Bipedal Locomotion,” Gait Posture, 21(3), pp. 350–362. [CrossRef] [PubMed]
Wilken, J. M., Rodriguez, K. M., Brawner, M., and Darter, B. J., 2012, “Reliability and Minimal Detectible Change Values for Gait Kinematics and Kinetics in Healthy Adults,” Gait Posture, 35(2), pp. 301–307. [CrossRef] [PubMed]
Dempster, W. T., 1955, “Space Requirements of the Seated Operator: Geometrical, Kinematic, and Mechanical Aspects of the Body With Special Reference to the Limbs,” Wright-Patterson Air Force Base, Dayton, OH, Technical Report No. 55–159.
Wu, G., and Cavanagh, P. R., 1995, “ISB Recommendations for Standardization in the Reporting of Kinematic Data,” J. Biomech., 28(10), pp. 1257–1261. [CrossRef] [PubMed]
Wu, G., Siegler, S., Allard, P., Kirtley, C., Leardini, A., Rosenbaum, D., Whittle, M., D'lima, D. D., Cristofolini, L., Witte, H., Schmid, O., and Stokes, I., 2002, “ISB Recommendation on Definitions of Joint Coordinate System of Various Joints for the Reporting of Human Joint Motion—Part I: Ankle, Hip, and Spine,” J. Biomech., 35(4), pp. 543–548. [CrossRef] [PubMed]
Grood, E. S., and Suntay, W. J., 1983, “A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee,” J. Biomech. Eng., 105(2), pp. 136–144. [CrossRef] [PubMed]
Baker, R., 2001, “Pelvic Angles: A Mathematically Rigorous Definition Which Is Consistent With a Conventional Clinical Understanding of the Terms,” Gait Posture, 13(1), pp. 1–6. [CrossRef] [PubMed]
Zeni, J. A., Jr., Richards, J. G., and Higginson, J. S., 2008, “Two Simple Methods for Determining Gait Events During Treadmill and Overground Walking Using Kinematic Data,” Gait Posture, 27(4), pp. 710–714. [CrossRef] [PubMed]
South, B. J., Fey, N. P., Bosker, G., and Neptune, R. R., 2010, “Manufacture of Energy Storage and Return Prosthetic Feet Using Selective Laser Sintering,” J. Biomech. Eng., 132(1), p. 015001 (1–6). [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

Clinically prescribed CF PD-AFO (IDEO, Brooke Army Medical Center, Fort Sam Houston, TX)

Grahic Jump Location
Fig. 2

The six regions evaluated in the AFO limb gait cycle: (1) first double support (AFO heel-strike to non-AFO toe-off), (2) early single-leg support and (3) late single-leg support (non-AFO toe-off to non-AFO heel-strike divided into two equal sections), (4) second double support (non-AFO heel-strike to AFO toe-off), (5) early swing, and (6) late swing (AFO toe-off to AFO heel-strike divided into two equal sections)

Grahic Jump Location
Fig. 3

Mean spatiotemporal parameters across subjects for the AFO and non-AFO limbs at the SS. No significant differences between AFO conditions were identified.

Grahic Jump Location
Fig. 4

Ensemble averaged joint angles for the AFO and non-AFO limbs at the SS across the gait cycle. Significant AFO main effects are depicted with an open circle () while significant differences between the CF and SLS AFOs within a leg are depicted with an asterisk ( *). Positive values represent ankle dorsiflexion, knee flexion, and hip flexion.

Grahic Jump Location
Fig. 5

Mean (standard deviation bars) GRF impulses across subjects for the AFO and non-AFO limbs at the SS across the six evaluated regions of the gait cycle: (1) first double support, (2) early single-leg support, (3) late single-leg support, (4) second double support, (5) early swing, and (6) late swing. No significant differences between AFO conditions were identified. Positive values represent propulsive, vertical, and medial GRF impulses.

Grahic Jump Location
Fig. 6

Ensemble averaged joint moments for the AFO and non-AFO limbs at the SS across the gait cycle. Significant AFO main effects are depicted with an open circle () while significant differences between the CF and SLS AFOs within a leg are depicted with an asterisk ( *). Positive values represent ankle dorsiflexor moments, knee flexor moments, and hip flexor moments.

Grahic Jump Location
Fig. 7

Mean (standard deviation bars) joint work across subjects for the AFO and non-AFO limbs at the SS across the six evaluated regions of the gait cycle: (1) first double support, (2) early single-leg support, (3) late single-leg support, (4) second double support, (5) early swing, and (6) late swing. Significant AFO main effects are depicted with an open circle () while significant differences between the CF and SLS AFOs within a leg are depicted with an asterisk ( *).

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